EP innovations at Inova Schar Heart and Vascular
Bachmann bundle and PFA
Reducing AFib risk for patients with pacemakers
A pacemaker implantation is often recommended for patients who present with a heart rhythm that is too slow. However, using traditional pacemaker implantation methods sometimes result in the onset of atrial fibrillation (AFib), which occurs in 30 to 50% of patients within the first few years after a pacemaker implant using traditional methods.
One contributor is how and where the heart is paced. Pacing the heart by placing wires in the traditional locations can cause atrial desynchronization, which enlarges the heart’s top chambers and can result in the initiation of AFib episodes. Correction of a slow heart rate with a pacemaker using traditional techniques may inadvertently accelerate development of AFib, causing symptoms and raising the patient’s stroke risk.
“We and others are developing a new and better way to pace the heart in order to try to prevent AFib from occurring,” said Brett Atwater, MD, D’Aniello Chair, Atrial Fibrillation and Section Chief of Electrophysiology at Inova Schar Heart and Vascular. “And that is through the use of a new location for placement of the atrial pacing wire: the Bachmann bundle.”
The Bachmann bundle extends from the sinus node to the left atrium, providing rapid electrical conduction of the signal through both the left and right atria. Inova is the only hospital in the Washington, DC, metropolitan area to offer Bachmann bundle pacing using Medtronic’s FDA-approved leads and catheters. By stimulating the Bachmann bundle, which connects the left and right atria, pacing closely approximates the normal electrical conduction pathway, leading to better cardiac function.
Inova’s electrophysiology (EP) team is now planning a major randomized, controlled trial that will seek to determine Bachmann bundle pacing’s impact on the amount of AFib patients experience after a pacemaker implantation to treat a too-slow heart rhythm.
Second-generation pulsed field ablation (PFA) with Affera™
Since 2021, Inova Schar Heart and Vascular has participated in several clinical trials for PFA and is the 14th site in the United States to get access to Medtronic’s Affera system, a second-generation mapping PFA system for AFib treatment. While first-generation systems have been available since early 2024, this version became available in January 2025. With ten Affera systems at three locations across the health system, Inova electrophysiologists have performed more ablations with the Affera system than anywhere else in the world – more than 900 and counting.
“The Affera system allows for faster procedures and potentially safer procedures. It also allows us to be much more flexible about where we place the ablation lesions for the treatment of AFib.” Dr. Atwater said. “It enables us to do exactly the procedure that we believe the patient needs, rather than a standard approach for everybody, which is what had been demanded by the form factor of the first-generation systems.”
Instead of thermal energy, PFA uses short bursts of high-frequency electric shock to temporarily open small holes in the atrial cell membrane, eliminating heart cells that cause A Fib without damaging other structures around the heart. PFA may result in more durable ablation, lowering the probability that electrical connectivity is restored to areas that may trigger AFib.
The Affera system has several benefits that contribute to its safety. First, it makes the procedure faster, reducing risk. Second, its precision form factor enables Inova’s EP teams to deliver energy more exactly, sparing healthy tissue. It has also been shown to have the highest probability of maintenance of sinus rhythm after a first procedure for persistent forms of AFib.
Inova Schar Heart and Vascular continues to contribute to the field’s understanding of PFA for AFib with ongoing outcomes research and efficacy data. Inova’s team has taken on challenging cases of persistent AFib using this system, testing its efficacy and the durability of its results.
“It’s allowing us to take on more challenging cases, and we’re doing them quickly, efficiently and safely, with a very high efficacy,” Dr. Atwater said. “This has expanded our ability to take care of AFib in people who have these more complex cases, which has been very meaningful for our patients.”
EP clinical trials
In September 2025, Inova began enrollment in the ELEVATE HFpEF trial. This trial is investigating whether increasing resting heart rate by pacemaker implantation may improve symptoms of shortness of breath and fatigue in patients with heart failure and a normal ejection fraction, a condition with few effective treatment options.
Dr. Atwater is the international co-principal investigator, and Inova Schar Heart and Vascular is the only recruiting site in the Washington, DC; Maryland; and Virginia region. The team hopes to enroll 15 to 20 patients in the next two to three years.
In late 2025, Inova Schar Heart and Vascular began enrollment in the Horizon 360 clinical trial, sponsored by Medtronic. This trial will evaluate the safety and efficacy of the novel Sphere 360 PFA catheter and the Affera mapping system for treatment of symptomatic paroxysmal AFib.
The unique catheter design may improve the durability of AFib ablation, reducing the need for repeat procedures, while simultaneously reducing procedural risks compared to current generation PFA products. Inova was selected as one of only 20 U.S. sites to provide early access to the Sphere 360 catheter through participation in the Horizon 360 trial.
Learn more about Inova’s heart rhythm expertise
Inova Schar Heart and Vascular is a regional and national leader in electrophysiology innovations, bringing the latest FDA-approved devices to patients and maintaining its status as a sought-after site for clinical trials of next-generation technologies. Inova is committed to offering these technologies across the health system at multiple hospitals. Regardless of where patients are seen at Inova, they have access to the best available treatments and technologies.